An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
I have covered many things on this page, including resuscitation and fluid responsiveness. Fluid responsiveness is a patient being given a certain amount of fluid, or a passive leg raise to assess how that will increase the cardiac output/index or stroke volume. This post will discuss stroke volume variation (SVV) and how it predicts fluid …
50000 followers on Instagram. Such a crazy number. Never would I have thought that the desire to learn evidence-based medicine to be so much that this many people would be reading my posts, commenting, and sharing with friends and colleagues. Ashley Adkins (@asheyadkinsrn) mentioned to me several months ago when we were both quickly ascending …
The blood pressure is low, give a bolus of fluids. Many times that leads to a "nurse dose" as many of us joke about. But are we causing harm? I keep reiterating that fluid responsiveness is when you achieve an increase in cardiac index/output or an increase in stroke volume due to that fluid or …
Continue reading IV Fluid Overload: Don’t Drown your Patients!
Dinosaurs still roam the earth, I know this. They are slowly and surely retiring, though. I trained in the days where Manny Rivers and the Surviving Sepsis Campaigns pushed for Early-Goal Directed Therapy were king. Hey, there was a reason why it was so successful, EGDT decreased in-hospital mortality from 46.5% to 30.5% in that …
This article is hot-off-the-press regarding vitamin C, thiamine and hydrocortisone in refractory septic shock. This regimen is known as HAT therapy in some corners of the world. It was actually published today, 5/5/20. It is NOT a randomized control trial but at least they went through the trouble of conducting a propensity matched, before-after, case …
Continue reading IV Vitamin C in Sepsis with Thiamine and Hydrocortisone
You've heard all these fancy terms, mixed venous blood gas, ScvO2, SvO2, thrown around the ICU all the time. Here, I explain what they are. Regardless of whether you're a nurse, respiratory therapist, medical student, resident, or even a fellow, these terms may sometimes be quite confusing as everyone talks about them like, "duh, you're …
Continue reading SvO2 and ScvO2 to Guide Resuscitation in Septic & Cardiogenic Shock
Back in December 2017, I found out that I had passed my ABIM board certification exam for critical care medicine. I created this video on youtube for those who are interested in learning about the methodologies I pursued to be able to pass this challenging exam. Needless to say, it was the most challenging board …
Continue reading ABIM Critical Care Board Certification Exam: How I passed my Boards
Several years ago, I took and passed my ABIM Board Certification exam for Internal Medicine. I made this video for YouTube when I was a younger whipper snapper and it has proven to have been quite helpful for some. In this video, I go over the different methods which I used to study for and …
Continue reading ABIM Board Certification Exam: Passing the Internal Medicine Boards
Ivermectin in COVID, this is the second time I cover this medication during this pandemic. Please note the date this blog post was written as things could have changed since then. This is NOT medical advice. This paper has NOT been peer reviewed. I will try to peer review it myself. Ultimately, I recommend you not …
Continue reading Ivermectin in COVID-19: Taking another look
How I wish that this was a positive study regarding Remdesivir. We’re in need of a helpful tool. I’ve thrown every possible treatment including tPA at patients to try to save them and nothing is 100% at this point. I took apart the first Remdesivir study several weeks ago and was not impressed. History is …